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Surgical Oncology Sep 2021The study aim was to systematically review literature evaluating surgeon volume-outcome relationships for thyroid and parathyroid operations in order to inform surgical...
BACKGROUND
The study aim was to systematically review literature evaluating surgeon volume-outcome relationships for thyroid and parathyroid operations in order to inform surgical quality improvement initiatives. Current literature suggests surgeons who perform a high volume of thyroid and/or parathyroid operations have better outcomes than low volume surgeons, though specific volume definition are not standardized.
METHODS
Eligible studies were selected through a literature search focused on the effect of surgeon volume on thyroid and parathyroid surgery patient outcomes. The literature search was conducted in accordance with the PRISMA guidelines. Publication dates extended from January 1998 to February 2021, and were limited to articles published in English.
RESULTS
A total of 33 studies were included: 25 studies evaluating thyroid surgery outcomes, 4 studies evaluating parathyroid surgery outcomes, and 4 studies evaluating both thyroid and parathyroid (mixed) surgery outcomes. Higher volume thyroid and parathyroid surgeons were found to be associated with fewer surgical and medical complications, shorter length of hospital stay, and reduced total cost when compared to lower volume surgeons. This volume-outcome relationship was also found to specifically affect the complication and recurrence rates for thyroid cancer patients undergoing surgery, especially for individuals with advanced stage disease.
CONCLUSION
The heterogeneity in cut-offs used for characterizing surgeons as high versus low volume, and also in subsequent patient outcome measures, limited direct study comparisons. The trend of improved patient outcomes with higher surgeon volume for both thyroid and parathyroid surgeries was consistently present in all studies reviewed.
Topics: Hospitals, High-Volume; Humans; Length of Stay; Outcome Assessment, Health Care; Parathyroid Neoplasms; Parathyroidectomy; Postoperative Complications; Prognosis; Thyroid Neoplasms; Thyroidectomy
PubMed: 33915486
DOI: 10.1016/j.suronc.2021.101550 -
Journal of Endocrinological... Jun 2021Parathyroidectomy (PTx) has an established benefit in patients with symptomatic primary hyperparathyroidism (PHPT). However, its efficacy in mild asymptomatic PHPT has... (Meta-Analysis)
Meta-Analysis
Efficacy of parathyroidectomy compared with active surveillance in patients with mild asymptomatic primary hyperparathyroidism: a systematic review and meta-analysis of randomized-controlled studies.
OBJECTIVE
Parathyroidectomy (PTx) has an established benefit in patients with symptomatic primary hyperparathyroidism (PHPT). However, its efficacy in mild asymptomatic PHPT has not been proven. This study aimed to systematically review and meta-analyze the best available evidence from randomized-controlled trials comparing the efficacy of PTx over conservative management (non-PTx) on skeletal outcomes [fractures and bone mineral density (BMD)], nephrolithiasis risk and quality of life (QoL) in patients with mild asymptomatic PHPT.
METHODS
A comprehensive literature search was conducted in PubMed, Scopus and Cochrane databases, from conception to February 23, 2020. Data were extracted from the studies that fulfilled the eligibility criteria and were synthesized quantitatively (fixed or random effects model) as relative risks and percentage mean differences (MD) with 95% confidence intervals (CI). I index was employed for heterogeneity.
RESULTS
Four studies were included in the meta-analysis. There was no difference in fracture risk between PTx and active surveillance. The PTx group demonstrated higher BMD [MD 3.55% (95% CI 1.81, 5.29) in lumbar spine and 3.44% (95% CI 1.39, 5.49) in total hip, without difference in femoral neck and forearm] and lower calcium concentrations (MD - 13.26%, 95% CI - 7.10, - 19.43) compared with the non-PTx group. No difference was observed between groups regarding nephrolithiasis or QoL indices, except for general health (higher in PTx group).
CONCLUSIONS
In patients with mild asymptomatic PHPT, PTx increases BMD and reduces serum calcium concentrations. However, its superiority over active surveillance in terms of fracture risk, nephrolithiasis and QoL cannot be supported by current data.
Topics: Asymptomatic Diseases; Conservative Treatment; Humans; Hyperparathyroidism, Primary; Parathyroidectomy; Randomized Controlled Trials as Topic; Treatment Outcome; Watchful Waiting
PubMed: 33074457
DOI: 10.1007/s40618-020-01447-7 -
The Journal of Clinical Endocrinology... May 2021Current data about the cardiovascular manifestations of mild primary hyperparathyroidism (pHPT) are often conflicting. Pulse wave velocity (PWV) is the gold standard for... (Meta-Analysis)
Meta-Analysis
CONTEXT
Current data about the cardiovascular manifestations of mild primary hyperparathyroidism (pHPT) are often conflicting. Pulse wave velocity (PWV) is the gold standard for assessing aortic stiffness, and it predicts cardiovascular morbidity and mortality.
OBJECTIVE
Primary outcomes were to investigate if mild pHPT was associated with higher PWV and if parathyroidectomy (PTX) reduced PWV in mild pHPT. Secondary outcome was to investigate blood pressure changes after PTX.
METHODS
Sources were PubMed, Google Scholar, SCOPUS, Web of Science, and the Cochrane Library. Eligible studies included reports of PWV in patients with mild pHPT and controls, or in patients with mild pHPT before and after PTX. Two investigators independently identified eligible studies and extracted data. Pooled mean difference (MD) was the summary effect measure. Data were presented in forest plots with outlier and influential case diagnostics. Nine observational studies and one randomized clinical trial were selected, including 433 patients with mild pHPT, 171 of whom underwent PTX, and 407 controls. PWV was significantly higher in mild pHPT than in controls (MD = 1.18, 0.67 to 1.68, P < .0001). Seven studies evaluated the effect of PTX on PWV. PTX significantly reduced PWV (MD = -0.48, -0.88 to -0.07, P = .022).
CONCLUSION
Aortic stiffness is increased in patients with mild pHPT, supporting the notion that mild pHPT is also associated with adverse cardiovascular manifestations. PTX significantly reduced arterial stiffness in mild pHPT, indicating that the benefit of PTX over cardiovascular manifestations should not be dismissed but it deserves further studies.
Topics: Aged; Female; Humans; Hyperparathyroidism, Primary; Male; Middle Aged; Parathyroid Hormone; Parathyroidectomy; Pulse Wave Analysis; Severity of Illness Index; Vascular Stiffness
PubMed: 33693666
DOI: 10.1210/clinem/dgab157 -
The Cochrane Database of Systematic... Apr 2024Home haemodialysis (HHD) may be associated with important clinical, social or economic benefits. However, few randomised controlled trials (RCTs) have evaluated HHD... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Home haemodialysis (HHD) may be associated with important clinical, social or economic benefits. However, few randomised controlled trials (RCTs) have evaluated HHD versus in-centre HD (ICHD). The relative benefits and harms of these two HD modalities are uncertain. This is an update of a review first published in 2014. This update includes non-randomised studies of interventions (NRSIs).
OBJECTIVES
To evaluate the benefits and harms of HHD versus ICHD in adults with kidney failure.
SEARCH METHODS
We contacted the Information Specialist and searched the Cochrane Kidney and Transplant Register of Studies up to 9 October 2022 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov. We searched MEDLINE (OVID) and EMBASE (OVID) for NRSIs.
SELECTION CRITERIA
RCTs and NRSIs evaluating HHD (including community houses and self-care) compared to ICHD in adults with kidney failure were eligible. The outcomes of interest were cardiovascular death, all-cause death, non-fatal myocardial infarction, non-fatal stroke, all-cause hospitalisation, vascular access interventions, central venous catheter insertion/exchange, vascular access infection, parathyroidectomy, wait-listing for a kidney transplant, receipt of a kidney transplant, quality of life (QoL), symptoms related to dialysis therapy, fatigue, recovery time, cost-effectiveness, blood pressure, and left ventricular mass.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed if the studies were eligible and then extracted data. The risk of bias was assessed, and relevant outcomes were extracted. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) or standardised mean difference (SMD) and 95% CI for continuous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Meta-analysis was performed on outcomes where there was sufficient data.
MAIN RESULTS
From the 1305 records identified, a single cross-over RCT and 39 NRSIs proved eligible for inclusion. These studies were of varying design (prospective cohort, retrospective cohort, cross-sectional) and involved a widely variable number of participants (small single-centre studies to international registry analyses). Studies also varied in the treatment prescription and delivery (e.g. treatment duration, frequency, dialysis machine parameters) and participant characteristics (e.g. time on dialysis). Studies often did not describe these parameters in detail. Although the risk of bias, as assessed by the Newcastle-Ottawa Scale, was generally low for most studies, within the constraints of observational study design, studies were at risk of selection bias and residual confounding. Many study outcomes were reported in ways that did not allow direct comparison or meta-analysis. It is uncertain whether HHD, compared to ICHD, may be associated with a decrease in cardiovascular death (RR 0.92, 95% CI 0.80 to 1.07; 2 NRSIs, 30,900 participants; very low certainty evidence) or all-cause death (RR 0.80, 95% CI 0.67 to 0.95; 9 NRSIs, 58,984 patients; very low certainty evidence). It is also uncertain whether HHD may be associated with a decrease in hospitalisation rate (MD -0.50 admissions per patient-year, 95% CI -0.98 to -0.02; 2 NRSIs, 834 participants; very low certainty evidence), compared with ICHD. Compared with ICHD, it is uncertain whether HHD may be associated with receipt of kidney transplantation (RR 1.28, 95% CI 1.01 to 1.63; 6 NRSIs, 10,910 participants; very low certainty evidence) and a shorter recovery time post-dialysis (MD -2.0 hours, 95% CI -2.73 to -1.28; 2 NRSIs, 348 participants; very low certainty evidence). It remains uncertain if HHD may be associated with decreased systolic blood pressure (SBP) (MD -11.71 mm Hg, 95% CI -21.11 to -2.46; 4 NRSIs, 491 participants; very low certainty evidence) and decreased left ventricular mass index (LVMI) (MD -17.74 g/m, 95% CI -29.60 to -5.89; 2 NRSIs, 130 participants; low certainty evidence). There was insufficient data to evaluate the relative association of HHD and ICHD with fatigue or vascular access outcomes. Patient-reported outcome measures were reported using 18 different measures across 11 studies (QoL: 6 measures; mental health: 3 measures; symptoms: 1 measure; impact and view of health: 6 measures; functional ability: 2 measures). Few studies reported the same measures, which limited the ability to perform meta-analysis or compare outcomes. It is uncertain whether HHD is more cost-effective than ICHD, both in the first (SMD -1.25, 95% CI -2.13 to -0.37; 4 NRSIs, 13,809 participants; very low certainty evidence) and second year of dialysis (SMD -1.47, 95% CI -2.72 to -0.21; 4 NRSIs, 13,809 participants; very low certainty evidence).
AUTHORS' CONCLUSIONS
Based on low to very low certainty evidence, HHD, compared with ICHD, has uncertain associations or may be associated with decreased cardiovascular and all-cause death, hospitalisation rate, slower post-dialysis recovery time, and decreased SBP and LVMI. HHD has uncertain cost-effectiveness compared with ICHD in the first and second years of treatment. The majority of studies included in this review were observational and subject to potential selection bias and confounding, especially as patients treated with HHD tended to be younger with fewer comorbidities. Variation from study to study in the choice of outcomes and the way in which they were reported limited the ability to perform meta-analyses. Future research should align outcome measures and metrics with other research in the field in order to allow comparison between studies, establish outcome effects with greater certainty, and avoid research waste.
Topics: Adult; Humans; Kidney Failure, Chronic; Renal Dialysis; Blood Pressure; Renal Insufficiency; Observational Studies as Topic
PubMed: 38588450
DOI: 10.1002/14651858.CD009535.pub3 -
Endocrine Apr 2021Primary hyperparathyroidism (PHPT) is associated with increased risk of cardiovascular morbidity and mortality. We aim to determine whether parathyroidectomy (PTX) can... (Meta-Analysis)
Meta-Analysis
PURPOSE
Primary hyperparathyroidism (PHPT) is associated with increased risk of cardiovascular morbidity and mortality. We aim to determine whether parathyroidectomy (PTX) can change cardiometabolic risk factors including serum lipids, glycemic parameters, systolic and diastolic blood pressure, C reactive protein (CRP), and body mass index (BMI).
METHODS
MEDLINE, Web of Science, Scopus, and Google Scholar were searched for relevant articles published till June 2020. Fixed-effect or random-effects models were used to estimate the weighted mean difference (WMD) and 95% CI for outcomes where applicable.
RESULTS
In total, 34 studies were eligible to be included in the current meta-analysis. Our results indicated no favorable change in serum triglyceride (n = 13, WMD = -0.06, 95% CI: -0.15, 0.03 mmol/L), total cholesterol (n = 15, WMD = 0.01, 95% CI: -0.14, 0.16 mmol/L), LDL-C (n = 10, WMD = -0.01, 95% CI: -0.17, 0.19 mmol/L), HDL-C (n = 10, WMD = 0.03, 95% CI: -0.001, 0.06 mmol/L), and CRP (n = 5, WMD = 0.82, 95% CI: -0.01, 1.64 mg/L) after PTX in PHPT patients. However, glucose (n = 24, WMD = -0.16, 95% CI: -0.26, -0.06 mmol/L), serum insulin (n = 12, WMD = -1.11, 95% CI: -1.73, -0.49 µIU/mL), systolic (n = 17, WMD = -10.14, 95% CI: -12.27, -8.01 mmHg), and diastolic (n = 16, WMD = -5.21, 95% CI: -7.0, -3.43 mmHg) blood pressures were decreased after PTX, whilst a significant increase was observed in BMI (n = 13, WMD = 0.35, 95% CI: 0.19, 0.51 kg/m).
CONCLUSIONS
PTX could improve glycemic parameters and blood pressure, without any significant change in serum lipoproteins and CRP.
Topics: Blood Glucose; Blood Pressure; Cardiometabolic Risk Factors; Humans; Hyperparathyroidism, Primary; Parathyroidectomy; Risk Factors
PubMed: 33057988
DOI: 10.1007/s12020-020-02519-7 -
Gynecological Endocrinology : the... Dec 2021Gestational primary hyperparathyroidism (PHPT) is an endocrinological disorder with serious outcomes for both women and neonates. The aim of our study was to present the...
OBJECTIVE
Gestational primary hyperparathyroidism (PHPT) is an endocrinological disorder with serious outcomes for both women and neonates. The aim of our study was to present the current evidence concerning the perioperative outcomes of pregnant women with PHPT who underwent parathyroidectomy during pregnancy.
METHODS
A meticulous systematic review of the literature published before February 2020 and all studies which presented perioperative and pregnancy outcomes off pregnant women who underwent parathyroidectomy for PHPT, were included.
RESULTS
A total of 53 were finally included, which reported 92 pregnant women who had parathyroidectomy during their pregnancy. A total of 46 patients were hospitalized due to significant complications of PHPT before their parathyroidectomy. With regards to surgical approach, 52.2% of patients underwent minimally invasive parathyroidectomy (MIP), while bilateral neck exploration (BNE) was 41.3% of cases. Only 4 women was not cured, whereas transient hypocalcemia was occurred in 18 patients. All cases proceeded to deliveries of healthy neonates, after their parathyroidectomy.
CONCLUSIONS
Parathyroidectomy during pregnancy is a safe and effective treatment option with minimum complications and probably should be considered as the treatment of choice in specific group of pregnant women with PHPT.
Topics: Female; Humans; Hyperparathyroidism, Primary; Parathyroidectomy; Pregnancy; Pregnancy Complications; Treatment Outcome
PubMed: 34044722
DOI: 10.1080/09513590.2021.1932801 -
International Urology and Nephrology Feb 2022The heightened fibroblast growth factor 23 (FGF23) level in patients with chronic kidney disease (CKD) is associated with increased cardiovascular disease and mortality.... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The heightened fibroblast growth factor 23 (FGF23) level in patients with chronic kidney disease (CKD) is associated with increased cardiovascular disease and mortality. We performed a systematic review and meta-analysis to synthesize the available strategies to reduce FGF23 in CKD patients.
METHODS
We conducted a meta-analysis by searching the databases of MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) and single-arm studies that examined the effects of dietary phosphate restriction, phosphate binders, iron supplements, calcimimetics, parathyroidectomy, dialysis techniques, and the outcome of preservation of residual renal function (RRF) on FGF23 levels in CKD patients. Random-effects model meta-analyses were used to compute changes in the outcome of interests.
RESULTS
A total of 41 articles (7590 patients), comprising 36 RCTs, 5 prospective studies were included in this meta-analysis. Dietary phosphate restriction less than 800 mg per day yielded insignificant effect on FGF23 reduction. Interestingly sevelamer, lanthanum, iron-based phosphate binders, and iron supplement significantly lowered FGF23 levels. In CKD patients with secondary hyperparathyroidism, calcimimetics prescription could significantly reduce FGF23 levels, while surgical parathyroidectomy had no significant effect. In dialysis patients, preservation of RRF and hemoperfusion as well as hemodiafiltration provided a significant decrease in FGF23 levels.
CONCLUSIONS
The present meta-analysis demonstrated that non-calcium-based phosphate binders including sevelamer, lanthanum, and iron-based phosphate binders, iron supplements, calcimimetics, hemoperfusion, and preservation of RRF could effectively reduce FGF23 in CKD patients.
Topics: Fibroblast Growth Factor-23; Humans; Renal Insufficiency, Chronic; Treatment Outcome
PubMed: 33797709
DOI: 10.1007/s11255-021-02848-0 -
Clinical Otolaryngology : Official... Nov 2019Cosmesis after surgical wound closure is an important outcome. This is relevant after thyroid and parathyroid surgery as anterior neck scars are visible and often of...
OBJECTIVES
Cosmesis after surgical wound closure is an important outcome. This is relevant after thyroid and parathyroid surgery as anterior neck scars are visible and often of concern to patients. We aimed to investigate whether wound closure method influences cosmetic outcome in thyroid and parathyroid surgery, in particular using sutures, staples, steri-strips and glue.
DESIGN
We performed a systematic review of MEDLINE, PubMed, EMBASE, CINAHL and Cochrane focusing on wound cosmesis following thyroid and parathyroid surgery. Searches were conducted using combinations of the search terms: thyroid/parathyroid surgery, wound/skin closure and suture, staples, clips, glue and steri-strips, using appropriate MESH terms and Boolean operators.
MAIN OUTCOME MEASURES
Primary outcome was wound cosmesis. Secondary measures were also extracted.
RESULTS
Initial search found 304 papers and after systematic review, a total of 10 studies compared different closure methods and cosmetic outcomes. There were nine randomised controlled trials and one cohort study, with a total of 712 patients. Three studies compared staples vs glue; three compared sutures vs clips; two compared suture vs steri-strips and two studies for suture vs glue. In general, short-term cosmesis was better with subcuticular sutures compared to glue or clips, long-term cosmetic outcomes were not influenced by closure method.
CONCLUSIONS
We found closure with subcuticular suture or steri-strips produced superior short-term cosmetic outcomes. Although long-term cosmetic outcome is not influenced by closure method, given the superior cosmetic outcome and advantage of not needing removal, we recommend subcuticular sutures should be performed for wound closure in thyroid and parathyroid surgery.
Topics: Humans; Parathyroidectomy; Sutures; Thyroidectomy; Wound Closure Techniques; Wound Healing
PubMed: 31145548
DOI: 10.1111/coa.13382 -
The American Surgeon Jun 2023To evaluate whether the application of carbon nanoparticles (CNs) in total or near-total thyroidectomy combined with central lymph node dissection (CLND) for thyroid... (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate whether the application of carbon nanoparticles (CNs) in total or near-total thyroidectomy combined with central lymph node dissection (CLND) for thyroid cancer (TC) is beneficial to lymph node dissection, parathyroid, and recurrent laryngeal nerve (RLN) protection.
METHODS
Relevant literatures were systematically searched on PubMed, EMBASE, and Cochrane Library Databases until March 31, 2021. All analyses were performed using Revman Manager 5.3 software. The main results were the number of central lymph nodes, the number of central metastatic lymph nodes, accidental parathyroidectomy, postoperative hypoparathyroidism, postoperative hypocalcemia, and postoperative transient RLN paralysis.
RESULTS
This meta-analysis identified 4 randomized controlled trials and 8 non-randomized controlled trials comprising 1870 patients. Compared with the control, the use of CNs was helpful to dissect more central lymph nodes (weighted mean difference [WMD]: 3.55, 95% confidence interval [CI]: 2.12-4.98, .00001) and central metastatic lymph nodes (WMD: 1.69, 95% CI:1.31-2.08, < .00001), lower rate of accidental parathyroidectomy (odds ratio [OR]: .33, 95% CI: .23-.47, .00001), lower rate of both postoperative transient hypoparathyroidism (OR: .40, 95% CI: .31-.51, .00001), and transient hypocalcemia (OR: .37, 95% CI: .27-.51, .00001). However, there were no statistical difference between the groups for postoperative permanent hypoparathyroidism (OR: .29, 95% CI: .06-1.28, .10), postoperative permanent hypocalcemia (OR: .94, 95% CI: .10-9.16, .96), and postoperative transient RLN paralysis (OR: .66, 95% CI: .40-1.12, .12).
CONCLUSIONS
The application of CNs in total or near-total thyroidectomy combined with CLND for TC can better dissect the central lymph nodes and protect parathyroid glands (PGs) and their function.
Topics: Humans; Thyroidectomy; Hypocalcemia; Neck Dissection; Thyroid Neoplasms; Lymph Node Excision; Lymph Nodes; Hypoparathyroidism; Vocal Cord Paralysis; Carbon; Nanoparticles; Retrospective Studies
PubMed: 35387525
DOI: 10.1177/00031348221086780 -
Otolaryngology--head and Neck Surgery :... Jan 2024To determine whether nonopioid analgesic regimens, taken after discharge for thyroid and parathyroid surgery have noninferior pain outcomes in comparison to opioid... (Review)
Review
OBJECTIVE
To determine whether nonopioid analgesic regimens, taken after discharge for thyroid and parathyroid surgery have noninferior pain outcomes in comparison to opioid analgesic regimens. Secondarily, we sought to determine if nonopioid analgesic regimens decrease the number of opioid medications taken after thyroid and parathyroid surgery, and to assess adverse events associated with opioid versus nonopioid regimens.
DATA SOURCES
PubMed, Embase, Cochrane.
REVIEW METHODS
A comprehensive search of the literature was performed according to the PRISMA guidelines, and identified 1299 nonduplicate articles for initial review of which 2 randomized controlled trials (RCTs) were identified as meeting all eligibility criteria. Meta-analysis was not conducted due to heterogeneity in the data and statistical analyses.
RESULTS
Both RCTs included in this systematic review found no significant differences in postoperative pain scores between individuals discharged with a nonopioid only analgesic regimen compared to analgesic regimen that included oral opioid medications. One study reported significantly increased number of postoperative calls related specifically to pain in the nonopioid arm compared to the opioid arm (15.6% vs. 3.2%, P = .045).
CONCLUSION
This systematic review of RCTs revealed a limited number of studies examining nonopioid versus opioid postoperative pain medications among adults who undergo thyroid and parathyroid surgery. Among the 2 RCTs on this topic, there is a shared finding that nonopioid analgesic regimens are noninferior to opioid analgesic regimens in managing postoperative pain after thyroid and parathyroid surgery, supporting the use of nonopioid pain regimens given the risk of opioid dependence associated with prescription opioid medications.
Topics: Adult; Humans; Analgesics, Opioid; Analgesics, Non-Narcotic; Thyroid Gland; Analgesics; Pain, Postoperative
PubMed: 37595107
DOI: 10.1002/ohn.503